“I don’t know what to do.” Andy’s mom is beside herself. Three-and-a-half-year old Andy bites and sucks the sleeves and collar of his shirts until they are soaking wet and ragged. She says she has tried everything: talking, scolding, ignoring, making him take his shirt off. Nothing works. If he is shirtless, he chews on his hand instead. She’s come for a consultation because she’s worried. He sometimes chews on his hand until it is red.
When a child shows such an unusual behavior, evaluation, not new discipline, is what is needed. Children’s behavior always makes a kind of sense. It’s our job to figure out what Andy is trying to tell us. Once we have a better understanding of what is going on, we may be able to help him out.
Many adults underestimate little kids. Sometimes kids absolutely do know what’s bothering them. They’re just not sure what the big people will do when they’re told. As soon as they know they won’t be scolded, many kids are quite forthcoming in their own kid way. Simply asking is always a good place to start.
Andy is an engaging little guy. He’s willing to chat. I notice that he sometimes bites his sleeve. Does he know why? He doesn’t. He says he doesn’t think he can help it; he wishes his mom didn’t get so upset; he doesn’t want to do it. It just happens.
I believe him. He has already shown me that he’s an exceptionally verbal and insightful three year old. I ask him if anything might be bothering him. He gets quiet and thoughtful. I ask him if maybe he can show me if he can’t tell me. This makes him curious. So we go over to my sand table to play.
A sand table is essentially a sandbox on short legs. There are lots of figures, toys, and objects available for a kid to play with in the sand. With some gentle questioning, most children get involved in playing their problem for the therapist. Once engaged in play, many children forget about the therapist entirely. They make a world for us to see.
Andy first chooses some cars and a bulldozer to try out the sand table. He glances at me for approval. “You can do what you want,” I tell him. “Vroom.” The bulldozer makes a road. “Vroom” go the cars in the new road. “The cars are going fast,” I say. “Vroom.” Cars start at opposite ends and crash. “Those cars made a great big crash,” I add. It’s important that I only note what Andy is doing and not judge it. Andy is doing what most kids do. He’s checking out if I meant it when I told him he could play anything he wants or if I’m going to get upset.
Reassured, he chooses a number of rubber boy and girl figures, a superhero action figure, and a box. Soon he is setting up a scene. The box, turned upside down, becomes a building. He places groups of children around it. One boy figure is apart from everyone else. Soon the superhero comes by. “Whish!” The superhero takes the boy flying on his back. Andy makes them swoop around the room and even under the table. He smiles and laughs, intently involved in his imaginary game with his superhero friend.
As he runs out of steam, I ask him what happens next. He makes the action figure fly off, leaving the boy figure in the sand. “That boy is by himself,” I say. Andy looks sad. Andy looks a little upset. Andy’s wrist goes to his mouth. I sit quietly. Andy looks at me, bewildered, sucking on his shirt cuff all the while. Then he bulldozes his scene.
Often a family therapist is as much detective as counselor. We look for clues and try to put the pieces together. Andy has given me a very strong hint about what may be troubling him. It’s my job to piece together the larger picture.
Filling in the Picture
While Andy continues to play at the table, I talk quietly with his mom to fill in the gaps. She and Andy moved to town only a few months before. Andy started in a new daycare while mom went to work as a nurse in the local hospital. She’s been able to arrange a four-day work week so Andy isn’t in daycare every day. Andy has never known his dad. It’s always been just the two of them.
“What about a social life for you two?” I ask. Mom laughs ruefully. With moving, establishing Andy in daycare, and starting a new job, it’s been all his mom could do to get settled. She’s met some of the other parents at the daycare center but she hasn’t yet had the time to get to know anyone. Mostly, she counts on her sister who lives in town for company. She’s glad that Andy has kids at daycare to play with. Before the move, he was taken care of by a sitter with only one other child.
She gives me permission to talk to the daycare center to get more information. I give her lots of support for how well she is handling such big life changes and suggest that this week, she just work on praising Andy whenever he isn’t chewing. She agrees that she can emphasize the positive while I find out more about her son.
The next day, I manage to connect with his daycare teacher. She confirms that Andy is an exceptionally smart little boy. He has a vivid imagination and the vocabulary of a much older child. At only 3 ½ he seems to be on the edge of learning to read. His teachers love his precocious insights and his polite manners.
“How is he doing with the other kids?” I ask. That’s another story. “He’s adjusting,” the teacher replies. “He tends to want to direct much more elaborate play than the other kids can follow, so they move away from him. It doesn’t seem to bother him, though. It’s as if he doesn’t notice when the kids drift away because he’s so deeply involved in some imaginary situation.”
“Does he chew on his shirt?” I ask. “Oh yes. It’s a habit he has,” she replies. “We’ll work on that when he is more comfortable.” I like this woman. She focuses on strengths and is taking things one step at a time.
This little boy has been sending out signals that he is having a harder time than the adults might think. Bright and creative, he has handled the stress of so much change in his life by withdrawing into his imaginary world. My guess is that sucking on his clothes is another way he soothes himself. Maybe it’s a holdover from the days of having a pacifier. Maybe it’s something that he just stumbled on one day as a way to distract himself and he found that it gave him some comfort. It works for him. It works so well that he hasn’t been able to give it up even though it displeases his mom. It’s to her credit that she reached out for some support and advice instead of getting more and more upset with her son for ruining his clothes or with herself for not being able to help him stop.
The next step is to meet Andy’s mom and his daycare teacher. Both think my theory may have merit. Together we come up with a plan. The teacher identifies a couple of kids who are also particularly imaginative in their play and agrees to set up some activities to help Andy know them better. She also asks her staff to be more active in helping Andy figure out ways to be one of the gang instead of hanging out with the teachers or being off in his own world. We both encourage his mom to linger at pickup time so that she and her son can get acquainted with other families.
Play dates soon followed, with both mother and son becoming more involved, and at ease, in their new community. Over the next few months, Andy gradually stopped chewing on his wrist or his clothes. Oh, every once in awhile he’d nibble but it was no longer a big deal. “I’m actually sort of glad Andy was eating his shirts,” his mom told me during a followup call. “If it hadn’t been for that, I wouldn’t have known he was upset. Things might have gotten much worse for him at daycare. Truth is, I would probably still be so caught up with all the details of my life that I wouldn’t have started to make new friends for myself either.”